An ongoing discussion of the changes and frustrations with medical care by an observer, participant and active provider of it.

Thursday, August 16, 2012

Dangerous 18 Hours Shifts in Nursing Homes

A nurse friend of my husband's was recently let go from a Kentucky nursing home for medication mistakes made while working two back-to-back, weekend, eighteen-hour shifts. I didn't believe that was possible under labor laws but I can find no maximum labor law covering how long people can be asked to work.

I'd be curious to know if this is a common practice in other places. I found this document, put out by the Department of Health and Human services, that described nursing homes using 16 hours shifts as non-traditional, flexible hours for employees. By the time you add in breaks and lunch, I assume this is the same scheduling my husband's friend was talking about working. There is no suggestion in this document that these hours might be dangerous to patient health. There are well documented studies illustrating the increasing errors that occur when nurses work more than 12 hour shifts[1].

Even if an individual conscientiously gets enough sleep prior to one 16-18 hour shift, there is not sufficient time to sleep enough when shifts are back-to-back on a weekend. The nurse described here found her abilities slipping, particularly as she entered the end of the second shift.

This kind of care is unconscionable and has no place in the care of our elderly population.

1. Roger,Ann. The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety. 2008, Apr.http://www.ncbi.nlm.nih.gov/books/NBK2645/

5 comments:

My mother is in a nursing home and I witness this all the time. Most nursing homes are for profit and they do not take into consideration the acuity level of the patients. My mother's roommate's daughter has caught medication errors on her mother. The aid on my mom's hall has to take care of 16 patients and 15 are pretty much full care. I have written to my representatives twice and have received no comments back from them. OIG has investigated several things at the nursing home. Still staffing is one of those nebulous areas in our wonderful Kentucky Commonwealth. It seems that our Commonwealth wants to control too many things with the Narcotic Bill, but forget about other areas that really need to be evaluated. What are sorry state of matters we are experiencing.

It is important that the number of hours shift of nurses in nursing homes must not be more than 12 hours. It is dangerous if it is more than that. Thanks for sharing the document here. I learned a lot.

I'm a new rn and got offered these exact hours. I refused as I am often asleep by 10. To ask a human to function efficiently and safely at this level of work and this many hours is incomprehensible. Nurses are people too. We can make errors. Unfortunately, if we make an error a life can hang in the balance. And, sadly for your husband's friend it did. All for that extra shift differential of 3 an hour. Our patients deserve better. I refused the position and took one at a facility that does not staff like this. Was a pay cut but worth my license that's for sure.

Kathy A Nieder MD

A Family Practice physician since 1984, Dr. Nieder has watched the evolution (and devolution) of Health "care" over the years. She decided to add her voice to the discussion by making observations of the practice of medicine today, a time when the negatives often seem to outweigh the positives as patients and doctors become increasingly disenfranchised by the fragmentation of medical care. All views are solely her own.

Kathy has been fascinated by "tech" since she bought her first Apple computer for the family in 1987. She is interested in Social Media in healthcare as well as smartphone apps and their impact on patient care, especially in primary care.

She is an employed physician for Baptist Medical Associates in Louisville, KY. She enjoys partnering with her patients and believes patients who are well-informed and take an active role in their own well-being make for healthier, more satisfied people who make better lifestyle choices.

As a "primary care doc", Dr. Nieder advocates for PHYSICIAN led teams that embrace patients in not only the chronic illness setting but in preventive programs as well.

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